Online OPAP Intake Form

If you are eligible and would like to become a member of East Creek Community Centre’s (ECCC) Older Person Action Program (OPAP), or have otherwise been directed to this webform by the OPAP Coordinator, please fill in as much of the form below as you are able. All responses are compulsory where indicated by a red ‘*’ icon, with optional responses as stipulated that do not require a response. If you require any assistance, feel free to contact the OPAP Coordinator at (07) 4639 2755 or 0468 792 755

By entering your name in this field (digital signature), you are consenting to East Creek Community Centre providing your services related to the Older Persons Action Program, and for information to be collected, accessed, used, stored and distributed in line with our Information Management, Privacy and Confidentiality Policies. You also consent that your information may be de-identified and used as for statistical purposes for reporting to any of East Creek's funding bodies. Should you not agree with any of the above statements or require clarification, please do not complete this form and contact a member of staff on (07) 4639 2755 or 0468 792 755.